| NPI | 1053411546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO MD115594) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2012-02-26 |